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LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. 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Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderWhat is organizational culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? Z-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. 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Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderWhat is organizational culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? Z-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiacP8 arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(z0  0 0(  x  c $MZC `}  Z x  c $TZD ` Z H  0޽h ? h80___PPT10.q`ArD5 0DX51$D(   ht  !"#$'&՜.+,D՜.+,    $ 8On-screen Show San Jose State Universityu, &Arial Wingdings @MS MinchoTimes New RomanSymbolRippleMicrosoft Clip Gallery2NURS 138 February 20, 2008 Organizational CultureQuestions to ConsiderOrganizational structure"Frameworks Organizational Culture Culture Culture of NursingMCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htmCulturally Competent SystemCultural CompetenceOrganizational Culture Organizational CultureOrganizational climateClimate Domains,Interactional Work-Unit Culture (Lashbrook)Organizational Subcultures Just CultureMeasurements of Culture/Hospital Survey on Patient Safety Culture AHRQResearch Issues Organizational Climate Research+Impact of Nursing Studies Patient OutcomesIOM Rules for Redesign (2001)IOM Redesign Rules6IOM Crossing The Quality Chasm: Changes Needed (2001)IOM Environment Changes (2003)OIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses Healthy Work Environment (AACN)IAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsKMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.*Innovation-Based Mission, Vision & Values Slide 31  Fonts UsedDesign TemplateEmbedded OLE Servers Slide TitlesX 8@ _PID_HLINKSAkhttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_i(_Q,Phyllis ConnollyPhyllis Connollyd=6011ess Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(zr#p51E(   http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011D/ 0|DArialew RomanTTܖx: 0ܖ"DWingdingsRomanTTܖx: 0ܖ D@MS MinchoomanTTܖx: 0ܖ0DTimes New RomanTTܖx: 0ܖ@DSymbolew RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` ;!HG  #$%&'()*+,./123467:O2$ЕK|MFCDew52$RN(:5$R$9i#\ CzG 0AA@8wʚ;ʚ;g4DdDdy x: 0ppp@ <4dddd  0Tl <4BdBd  0T80___PPT10 ?  %<1NURS 138 February 20, 2008 Organizational CultureCPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:\-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(z0  0 0(  x  c $$C `}   x  c $H'D `  H  0޽h ? h80___PPT10.q`Ar5051E(   http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011D/ 0|DArialew RomanTTܖx: 0ܖ"DWingdingsRomanTTܖx: 0ܖ D@MS MinchoomanTTܖx: 0ܖ0DTimes New RomanTTܖx: 0ܖ@DSymbolew RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` ;!HG  #$%&'()*+,./123467:O2$ЕK|MFCDew52$RN(:5$R$9i#\ CzG 0AA@8wʚ;ʚ;g4DdDdy x: 0ppp@ <4dddd  0Tl <4BdBd  0T80___PPT10 ?  %<1NURS 138 February 20, 2008 Organizational CultureCPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:\-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. 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@~2_b߾ V_+}~gFad}*{SL~>%*\r=2HZMиnb7j_{Ӛ^U;zP(}FӻzQL9否^q?47FO=vJ}^ S+IM/Tmm'h{>6㟵o:]VhhfŚfhi&Zi,ѨFRh0UeWɨ֤R5IMz&*ytient+AND+safety+AND+culture&doc_id=6011D/ 0|DArialew RomanTTܖx: 0ܖ"DWingdingsRomanTTܖx: 0ܖ D@MS MinchoomanTTܖx: 0ܖ0DTimes New RomanTTܖx: 0ܖ@DSymbolew RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` ;!HG  #$%&'()*+,./123467:O2$ЕK|MFCDew52$RN(:5R$Y ؕ26H1IR$9i#\ CzG 0AA@8wʚ;ʚ;g4BdBdy x: 0|ppp@ <4dddd  0Tl <4BdBd  0T80___PPT10 ?  %e<1NURS 138 February 20, 2008 Organizational CultureCPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. 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LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(z  0L0 <(  <~ < s * C `}   ~ < s * D `   d < c <A 4yhjukaw[1]p  H < 0޽h ? ff9ŋf\l___PPT10i.-+D=' Z= @B +rǧ 51F(   http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+sar  3BGhq& ZsMBϟv@E /75e^n)N0y n/Ls8 Ni@EXް6frAuu5tuuQszXkb>8$I- 6~)kÿlQ[/-0n0-o CӲJ83ш3fclɴ(¢ ɤP I,qZC#coCT1{ )/"_QD'ٝpI&*WE{ T1{Ϧm:+:,iΏa4RL׷iu_P5}Rƒ29B( c-˰Np|ƣqmhl}|Ʃ~-"O pz؎_B!LQGU,]54W9SJ>- 4^)F;܏u*'X^6TGԫb2z2XQ |:G4M#} cB?m+ԊYl')SGē+r)S<@ b cP1tjs;W[Z-Lk`OA N0c!q,TFe˪LT3y?<֐!plM>IɅ|J? Hr:Q/pCgxqaX;Kš̏d\6Z%۲ 8$&J񄖆pE5 2S;F;jR*#--3nyw,ʏߩ+UkXt&n=< !U8pٌi[WB+8t#c%zN$6oʯ Fs?tKYY(:E'aF_8|G5/sTXOalz7Uk[r8e.o _IB's?82} ɨ>q83ͩ =Q9{xYbS9yT~ (V3ͩv)ƈvZ|&`iO͟y !֠FgH%@i)%j@EVwJFIFddDucky<Adobed        !1AQa"q2BR#br3S$4TCcs£D%U5!1AQaq"2bB# ?fety+AND+culture&doc_id=6011http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=60116Clip (MS_ClipArt_Gallery.20,Microsoft Clip GalleryD/ 0|DArialew RomanTTܖx: 0ܖ"DWingdingsRomanTTܖx: 0ܖ D@MS MinchoomanTTܖx: 0ܖ0DTimes New RomanTTܖx: 0ܖ@DSymbolew RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` XP<!HG  #$%&'()*+,./123467:o2$ЕK|MFCDew52$RN(:5R$Y ؕ26H1IR$9i#\ CzG2$[54] \"; 2$=>2@%iRQ;dN3+ 0AA@8wʚ;ʚ;g4BdBdy x: 0|ppp@ <4dddd  0Tl <4BdBd  0T80___PPT10 ?  %e<1NURS 138 February 20, 2008 Organizational CultureCPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38)Z, Z,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. 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How can you influence the organizational culture? :Z:-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of p      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcderceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38),,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(z)  0 @8(  r  S  C `}   x  c $(S D       ^ADmodule2&  H  0޽h ? h___PPT10i. qp+D='  = @B +gxX lV~smK[+hUXReZ mcZ,oLFe2$02, [e.Y[mv[e?={åu$ yz99={:5AKH'PҐ1D"m?/%Eq ͋Bk&@ 0Hҽ9Ytqi/Jt'mBH[GQjdsP7 \s[6ڔk63bEqJ$x=aM!_~ H 0nWAƦGgi3w4~5Fצ+gۋXS̲ Jr2a LO?E&':M2,`p 0d9l29D4> |F&iX ,> u+ۀd6ہ"X ww:5)ȳo^V~s}M41uuuՍ[)~o1.>H|#HU+ ( C&Lv/vf'Ӝ%)]LNwVŻ{njNI9o$gwUjR=^-zc9ΘrꕑȔ!1R_)Nw渡}]af*G΂76Ό"b7y&cctw={)7x}^Ǹwṕ~;f?M{ pݩHPF @n<ى3 T#i{T?HjXM?)8o˹*KdesJxթZzd~-:wvWoؽ_F{d37W褽. }'U](*3֪tCh9tdGC3xFԶI"R]B/J?-G9og4#c+[ 5>4!'(㩺@ұvX$-Ώy-`>٩$;?ʧLvߐ;翥>$^-*/.&6;vD@Ѵdz0tذ;?dʜ+z6J۴ʰڧ7ܮxկ1}⯺7ڳ&#B}v4ϝC=ʗ͓織ڬ1;ڱʰ@𛯪=߲ϵU=(´+_>7:ʸ׬5ճڞG:2GE3}][N xayW,dpbwŽtF+"Cyu6?ZHqɊһ"ūVG] 7_vLo{ȴMhs;7Cf3}ïtm<+O׵]hS0m~ ٝʯD9WgENk-FRG>SnEꠑ0 4V↏R-mqpBa֘o&q5>+b']etnS/rC)6$B\61F(   http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=60116Clip (MS_ClipArt_Gallery.20,Microsoft Clip GalleryD/ 0|DArialew RomanTTܖx: 0ܖ"DWingdingsRomanTTܖx: 0ܖ D@MS MinchoomanTTܖx: 0ܖ0DTimes New RomanTTܖx: 0ܖ@DSymbolew RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` |<!HG  #$%&'()*+,./123467:42$ЕK|MFCDew52$RN(:5R$Y ؕ26H1IR$9i#\ CzG2$[54] \"; 2$=>2@%iRQ;dN3+R$%@i)%j@EVwoH^ 0AA@8wʚ;ʚ;g4BdBdy x: 0|ppp@ <4dddd  0Tl <4BdBd  0T80___PPT10 ?  %!<1NURS 138 February 20, 2008 Organizational CultureCPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38),,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(zgxX lV~smK[+hUXReZ mcZ,oLFe2$02, [e.Y[mv[e?={åu$ yz99={:5AKH'PҐ1D"m?/%Eq ͋Bk&@ 0Hҽ9Ytqi/Jt'mBH[GQjdsP7 \s[6ڔk63bEqJ$x=aM!_~ H 0nWAƦGgi3w4~5Fצ+gۋXS̲ Jr2a LO?E&':M2,`p 0d9l29D4> |F&iX ,> u+ۀd6ہ"X ww:5)ȳo^V~s}M41uuuՍ[)~o1.>H|#HU+ ( C&Lv/vf'Ӝ%)]LNwVŻ{njNI9o$gwUjR=^-zc9ΘrꕑȔ!1R_)Nw渡}]af*G΂76Ό"b7y&cctw={)7x}^Ǹwṕ~;f?M{ pݩHPF @n<ى3 T#i{T?HjXM?)8o˹*KdesJxթZzd~-:wvWoؽ_F{d37W褽. }'U](*3֪tCh9tdGC3xFԶI"R]B/J?-G9og4#c+[ 5>4!'(㩺@ұvX$-Ώy-`>٩$;?ʧLvߐ;翥>$^-*/.&6;vD@Ѵdz0tذ;?dʜ+z6J۴ʰڧ7ܮxկ1}⯺7ڳ&#B}v4ϝC=ʗ͓織ڬ1;ڱʰ@𛯪=߲ϵU=(´+_>7:ʸ׬5ճڞG:2GE3}][N xayW,dpbwŽtF+"Cyu6?ZHqɊһ"ūVG] 7_vLo{ȴMhs;7Cf3}ïtm<+O׵]hS0m~ ٝʯD9WgENk-FRG>SnEꠑ0 4V↏R-mqpBa֘o&q5>+b']etnS/r6@|61F(   http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=6011http://www.qualitytools.ahrq.gov/summary/summary.aspx?txtSearch=patient+AND+safety+AND+culture&doc_id=60116Clip (MS_ClipArt_Gallery.20,Microsoft Clip GalleryD/ 0|DArialew RomanTTz ܖx: 0ܖ"DWingdingsRomanTTz ܖx: 0ܖ D@MS MinchoomanTTz ܖx: 0ܖ0DTimes New RomanTTz ܖx: 0ܖ@DSymbolew RomanTTz ܖx: 0ܖ@ .  @n?" dd@  @@`` |<!HG  #$%&'()*+,./123467:42$ЕK|MFCDew52$RN(:5R$Y ؕ26H1IR$9i#\ CzG2$[54] \"; 2$=>2@%iRQ;dN3+R$%@i)%j@EVwoH^ 0AA@8wʚ;ʚ;g4DdDdЭx: 0ppp@ <4dddd  0Tlz  <4BdBd  0T80___PPT10 ?  %D<1NURS 138 February 20, 2008 Organizational CultureDPhyllis M. Connolly, PhD, APRN-BC Professor School of Nursing, 91ý" 50Questions to ConsiderrWhat is organizational culture? Why is it important for you to understand an organization s culture? How do you measure organizational culture? What is the relationship between culture and patient outcomes? What has nursing done about a healthy work environment? How can you influence the organizational culture? :Z:-(Organizational structure & is the framework of an organization in which work activities and functions are organized to accomplish the mission and objectives.,  3.!Frameworks Organizational Culture""(iPower Role Task Personal (Handy, 1985) All contribute to a healthy work environment (Kane-Urrabazo, 2006)('C'CZCulture   Life style Transmitted from one generation to another Ideas, customs, skill, and arts Beliefs, values, moral principles, habits Language, rules of behaviors, economics Politics, health beliefs Basis for present behavior Contributes to continuity toward the futureB6ZZ,Z6,.)Culture of NursingStandards of Practice Code of Ethics Nursing s Social Policy Statement Education Nurse Practice Acts Licensure/*LCalifornia Nursing Practice Act (2001) http://www.rn.ca.gov/practact/b&p.htm M'(& 2725 Practice of nursing functions  & those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill, including:&  SS&!Culturally Competent System Values diversity Has the capacity for cultural-self-assessment Is conscious of the dynamics inherent when cultures interact Has institutionalized cultural knowledge Develops adaptations to diversity Services Are: Available Accessible Affordable Acceptable Appropriate.Z7Z7'"Cultural CompetenceSet of congruent behaviors, attitudes, and policies that come together in a system , agency, or among professionals that enable them to work effectively in cross cultural situations. Focal Point, 3(1) Fall 1988&Z  Organizational Culture Schein (1992) Levels Artifacts Espoused values Basic underlying assumptions Set of solutions devised by a group of people to meet specific problems rules seldom written stories, metaphors, rituals, use of space & time maintenance of relationships calls to accountability\Z7ZHZ|Z7H| Organizational Culture (& is the sum total of an organization's beliefs, norms, values, philosophies, traditions and sacred cows Organizational practices Vision statements  normative glue preserves and strengthens group maintain equilibrium Related terms: Work Environments Human Resource Practice thZZ*ZZh"*" " Organizational climate & is the personality of an organization, the perceptions and feelings shared by members of the system. Atmosphere, moveable set of perceptions related to working and practice conditions influenced by management  Climate Domainst Core Climate opinions about leaders values & strategies & structural characteristics (communication, governance, & information technology)  Process Climate perceptions of work conditions, supervision, work design, group process, & commitment to quality Can change within months & weeks (Clark, 2006, p.258) PPtP"PPPX"!""+Interactional Work-Unit Culture (Lashbrook)$  &Mission Goals Feedback Rewards Support"Organizational SubculturesSafety culture and climate Error Reporting culture and climate Culture of safety Learning Culture Mentoring Culture Nursing Culture Just Culture Nurse Friendly CultureZ(# Just CultureLSafer healthcare requires organizations to become transparent in error disclosure  having no secrets, Transparency leads to accountability Transparency builds trust through disclosure of the problems but a  just culture must exist Nurse leader must create environment so that every member of team feels responsibility & is accountable for ensuring the value of keeping patients safe (Vogelsmeier & Scott-Cawiezell, 2007)P,  #Measurements of CultureQuantitative and qualitative fieldwork techniques Scott, Mannion & Davis (2003) identified 9 instruments AHRQ Safety Culture Survey Tool (2004) University of Texas, Center of Excellence for Patient Safety Research & Practice91,.Hospital Survey on Patient Safety Culture AHRQ//(khttp://www.qualitytools.ahrq.gov/summary/summary.aspx?txt91ý=patient+AND+safety+AND+culture&doc_id=6011 X 0j$Research IssuesReliability of measurement options limited in linking positive safety outcomes with culture Types of outcomes data related to safety which can be collected in a cost-effective manner in sufficient scale are limited (Clark, 2006, p. 264) Only 29 studies met inclusion criteria of 7000 hits Scott-Findlay & Estabrooks (2006) Variations in cultural definitions, theories, & unit of analysis 8 different culture instruments Increase in research Methodological and conceptual challenges .DPPD2 % Organizational Climate Research (Evidence associated with percutaneous injuries with sharps & other blood borne pathogen exposures among health care workers. Compliance with universal precautions linked to management support, hindrances & feedback/training in nurses in 177 urban hospitals; injuries were linked to hindrances alone (Grosch et al.1999). UP and 225 correctional health workers & climate (Gershon et al. 1999).Z> A+&*Impact of Nursing Studies Patient OutcomesxNeedleman et al.(2002) 1997 data hrs care/day RNs medical pts. LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest &  failure to rescue hrs. care/day RNs surgical pts. UTI,  failure to rescue Aiken et al.(2003) 10% in proportion of BSN 5% risk of patient death &  failure to rescue !!\"3!!\"  3 4 IOM Rules for Redesign (2001)Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based IOM Redesign RulesSafety is a system property Transparence is necessary Needs are anticipated Waste is continuously decreased Cooperation among clinicians is a priority  5IOM Crossing The Quality Chasm: Changes Needed (2001)66$:Safe Effective Patient-centered Timely Efficient Equitable IOM Environment Changes (2003)Applying evidence to health care delivery Using information technology Aligning payment policies with quality improvement Preparing the workforce*%NIOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses[Address management practices Workforce capability Work Design Organizational safety culture)$Healthy Work Environment (AACN) ( Organizational cultures based on secrecy, professional protectionism, defensive behaviors, and inappropriate deference to authority are unhealthy and can lead to patient harm. (Fontaine & Gerardi, 2005, p. 38),,'HAACN Standards for Establishing and Sustaining Healthy Work EnvironmentsII$Standard 1 Skilled Communication SBAR (situation, background, assessment & recommendation) Standard 2 True Collaboration Standard 3-- Effective Decision Making Standard 4 Appropriate Staffing Standard 5 Meaningful Recognition Standard 6 Authentic Leadership (AACN, 2005)X!Z:ZZ Z!: 0+JMagnet Recognition Program The Magnet Recognition Program affords important national recognition to health care organizations that demonstrate sustained excellence in nursing care. It is the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services health organizations.$K. 4/)Innovation-Based Mission, Vision & Values**( Mission: To provide excellent patient care that provides value and makes a difference in people s lives. Vision: To be the market leader of quality, service, and cost-effectiveness in health care. Values: Participation, multiple intelligences, creativity, risk taking, respect for chaos, vulnerability leadership, evidence-based processes, and measurement. Porter-O Grady & Malloch (2007, p. 207)rjZZ\ZZZ(Z(z 0  *(  x  c $Bp  r  S C 0   H  0޽h ? 33___PPT10i.p ş+D=' = @B +r)9,61